10/25 Eating Disorders - Frenkel Flashcards
anorexia nervosa
diagnostic criteria
- restriction of energy intake relative to requirements leading to significantly low body weight in context of age, sex, developmental trajectory, and physical health
- intense fear of weight gain/becoming fat, behavior that interferes with weight gain (despite being underweight)
- disturbance in way weight or shape is experienced
types:
- restricting type
- bing-eating/purging type
medical complications of AN
- low bp
- amenorrhea and repro problems
- kidney issues
- GI issues
- osteoporosis
- edema
- cardiac irreg
Keys Starvation study
in WWII, group of conscientious objector agreed to go on a starvation diet for signif period of time (~6mo)
researchers learned that following behaviors are secondary effects of starvation → heavy overlap with anorexia
- food preoccupations
- bizarre eating habits
- incr irritability
- incr depression
- impaired concentration
- sleep difficulty
- decr sexual interest
- social isolation
bulemia nervosa
diagnostic criteria
recurrent episodes of binge eating characterized by:
- eating MORE FOOD in discrete amt of time than typically expected
- lack of control over eating during episode
recurrent inapprop compensatory behavior to prevent weight gain
- purging
- exercise purging
episodes occuring at least weekly for 3mo
overemphasis on body shape or weight on self-eval
episodes occuring NOT solely during episodes of AN
medical consequences of BN
- eletrolyte imbalance (due to purging)
- cardiac irreg
- dental problems
- damage to throat, esophagus, stomach
- laxative dependence
- GI issues
binge eating disorder
diagnostic criteria
recurrent episodes of binge eating characterized by:
- eating more than typically expected in a discrete amt of time
- lack of control over eating during the episode
binge eating episodes are associated with 3+ of following
- eating more rapidly than normal
- eating until feeling uncomfortably full
- eating large amt of food when not physically hungry
- eating alone (embarassed about amt of consumption)
- feeling disgusted with self, depressed, guilty afterwards
marked distress regarding binge eating
on avg, at least weekly for 3mo
not associated with recurrent use of compensatory behavior, does not occur during course of AN or BN
medical consequences of BED
- significant weight gain (sometimes, not always)
- high bp
- high cholesterol
- incr risk of diabetes
emotional and cognitive chars of eating disorders
- mood shifts (incl depression, sadness, guilt, self-hate)
- fear of becoming fat
- fear of food/situations with food present
- perfectionisitic attitude, self-criticism
- insecurities, issues with self-worth
- need for approval
- withdrawal
- may or may not want help
- anorexics often resistant (proud)
- bulemics want help with purging (shame) but still want weight loss
- binge eaters want to eat but without weight gain
physical signs of eating disorders
- significant shifts in weight
- loss of menstrual cycle or menstrual irregularities without other med reason
- paleness, cold, lanugo (hair growth to assist with coldness)
- impaired concentration
etc.
behavioral signs of eating disorders
- signs of restricted eating (severe diets, fasting)
- odd food rituals
- rigid exercise regimes
- dressing in layers (hide wt loss)
- binge eating
- purging
- use of laxatimes, diuretics, diet pills, enemas
- secretive eating
- excessive br visits after eating
- preoccupation with food/weight
- avoidance of social events with food
other specified feeding or eating disorder
all criteria for AN met BUT weight in normal range despite significant weight loss
criteria met for BN/BED except for frequency
1. avoidant/restrictive food intake disorder (ARFID) → picky eating (mostly kids) but dont have body-image issues
- weight loss, picky eating without body image disortion
- common among pt with Parvasive Devptal Disorders
2. purging disorder
- in approp compensatory behavior after eating small amt of food (in individ with normal body weight)
3. rumination
4. night eating syndrome
ddx for AN, BN, BED
- significant weight loss
- restricting
- binge-eating
- purging
unique combos:
AN = significant weight loss + restricting
BN = binging + purging
BED = binging + NO purging
medical conditions that can mimic or cause ED-like sx
psych conditions “”
med: seizure disorders, CJD, Cushings Syndrome, others
psych: dementia, depression cause lack of appetite
epidemiology keys: AN
women:men
peak age of onset
3:1 women:men
peak age of onset: 14-18
epidemiology keys: BN
higher prevalence for subthreshold BN
approx 75% female
onset: late adolescence-young adulthood
epidemiology keys: BED
3% of adults
5-8% of obese adults!
- but 70% of adults with BED are obese
equal representation across Caucasian, AfAm, Latino communities
approx 50/50 female/male
etiology of EDs
etiology is incompletely understood
- many contributory factors
- few specific risk factors consistently replicated in studies
common risk factors:
- sex, race/ethnicity
- childhood eating or GI problems
- elevated shape/weight concerns
- neg self-eval
- sexual abuse/other adverse events
- gen psych comorbidity
obesity paradox
multiple studies show that pt with heart failure, diabetes, kidney disease, stroke, etc who are overweight or obese live longer and have fewer medical complications than normal weight or thin patients
possible explanations:
- genetics
- differential tx
- thinness is NOT equivalent to fitness
treatment for ED
biopsychosocial approach
biological interventions
- medical tx
- nutritional rehab
- use of medications
behavioral interventions
psych interventions
multidisciplinary tx team:
- pediatrician, internist, adolescent med specialist
- psychiatrist
- therapist
- dietician
nutritional tx for AN
weight restoration
- 100% of ideal body weight in premenarcheal female
- 90% + return of menses for postmenarcheal female
- 90% for males
re-establish regular pattern of eating, decr dietary restriction
strategy: exposure plus response prevention to food
nutritional tx for BN and BD
- cessation of binge eating and/or purging
- establish regular pattern of eating
- exposure plus response prevention
- mindful eating
GOAL IS NOT WEIGHT LOSS → dont want to get them slipping into AN
most effective tx for adolescent anorexia nervosa
familty based treatment!
pharmacological treatment for EDs
AN: none
BN: almost all antidepressants effective in short term (regardless of comorbid depression or not)
- fluoxetine (Prozac) is FDA approved
BED: Vyvanse was FDA approved in 2015
bupropion in contraindicated for EDs
outcome of AN and BN
EDs have the highest mortality rate of all psych disorders
poor prognostic factors:
- vomiting (AN) or higher freq of vomiting (BN)
- lower weight
- higher levels of depression or compulsivity
- incr age
- length of illness
- treatment failure
outcome of BED
weight cycling found to be more dangerous than maintenance at a higher weight
- i.e. tx goal: weight maintenance and intuitive eating (NOT WEIGHT LOSS)
no evidence for efficancy of applying addiction model! → increases restrictive mindset!
CBT, IBT, Guided Self-Help are all more effective than behavioral weight loss treatment
